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Review
. 2022 Mar;49(1):149-166.
doi: 10.1016/j.clp.2021.11.009. Epub 2022 Jan 21.

Percutaneous Closure of Patent Ductus Arteriosus

Megan Barcroft  1 , Christopher McKee  2 , Darren P Berman  3 , Rachel A Taylor  3 , Brian K Rivera  4 , Charles V Smith  5 , Jonathan L Slaughter  6 , Afif El-Khuffash  7 , Carl H Backes  8
Affiliations
Review

Percutaneous Closure of Patent Ductus Arteriosus

Megan Barcroft et al. Clin Perinatol. 2022 Mar.

Abstract

Percutaneous-based patent ductus arteriosus closure is technically feasible among infants less than 1.5 kg. However, marked heterogeneity in the type and nature of adverse events obscures current safety profile assessments. Although data on the risks of postdevice closure syndrome remain promising, a lack of comparative trials of surgical ductal ligation and inconsistent surveillance across published studies obscure confidence in present estimates of safety and efficacy. To minimize risk and yield the greatest benefits, clinical studies of patent ductus arteriosus treatment should consider incorporating more robust assessments to ensure that infants at greatest risk for adverse ductal consequences are included.

Keywords: Catheter-based closure; Patent ductus arteriosus; Percutaneous closure; Preterm infant; Very low birth weight infant.

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Conflict of interest statement

Disclosure The authors have no financial relationships relative to this article to disclose. All authors have no conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
Pre-procedural intraprocedural flowchart.
Figure 2:
Figure 2:
Transthoracic echocardiography to assess the size of the patent ductus artiosus (PDA) (a), and obtain baseline Doppler velocities of descending aorta (DAO) (b) and left pulmonary artery (LPA).
Figure 3:
Figure 3:
To minimize the mismatch of the delivery catheter over the coronary wire (a), a microcatheter is advanced ahead of the TorqVue™ delivery catheter to smooth the transition through the tricuspid valve (b).
Figure 4:
Figure 4:
A wire (indicated by multiple *) courses through the delivery catheter from the inferior vena cava to the right atrium (RA), right ventricle (RV), and main pulmonary artery (MPA), across the PDA, and to the descending aorta (DAO). The TorqVue™ delivery catheter is withdrawn to the aortic ampulla to facilitate angiography (a) and obtain measurements of ductus (b). An esophageal temperature probe (arrow) typically serves as a surrogate marker for the aortic ampulla. This patient also has a feeding tube.
Figure 5:
Figure 5:
In a lateral projection, the aortic disc is deployed first (a) and withdrawn into aortic ampulla (b) prior to delivery of central body and pulmonary artery disc (c). The device may reorient during delivery process with loss of tension on delivery cable. The device remains attached to delivery cable at this stage.
Figure 6:
Figure 6:
Prior to release, echocardiography is performed of the LPA (a) and aortic arch, demonstrating no obstruction of flow to the descending aorta (DAO) nor left pulmonary artery (LPA). The device (*) is positioned within the ductus, and there is trivial residual shunt (arrow) through device. Additional considerations may include MPA angiography through the delivery catheter (b). When satisfied with TTE, exam, and fluoroscopic / angiographic assessments, the device is released by unscrewing the delivery cable (c).
Figure 7:
Figure 7:
Anteroposterior (a) and cross-table lateral (b) chest X-rays are obtained the day following the procedure, demonstrating stable lung findings and the device in stable position. Post-procedural echocardiography (c) demonstrates trivial residual shunt (arrow), which was no longer visualized on subsequent echocardiograms in this patient.
See this image and copyright information in PMC

References

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